Ep. 82: Erectile Dysfunction & Heart Disease: The Connection You Can't Ignore

Transcript

Ep. 82 - Erectile Dysfunction & Heart Disease: The Connection You Can't Ignore

Host: Dr. Kanwal Bawa | Guest: Dr. Jyoti B. Mohanty | Runtime: 26:59 | Published: February 28, 2023

00: 12 | ED as a Warning Sign for Heart Disease

Dr. Bawa: Welcome to the Dr. Sex Fairy podcast. I am Dr. Kanwal Bawa, America's favorite sex doctor, and I am here to transform your life. We often talk about erectile dysfunction or ED, which is the inability to get or maintain an erection sufficient for sexual intercourse. Today we are going to discuss a topic you have likely never thought. Did you know that there is a major connection between erectile dysfunction and heart disease? In fact, men who suffer from erectile dysfunction are twice as likely to suffer from heart disease according to the American College of Cardiology. Erectile dysfunction and cardiovascular disease share certain risk factors. These include age, sedentary lifestyle, obesity. Smoking, high cholesterol, metabolic syndrome, high blood pressure, diabetes, and more. Studies have found that erectile dysfunction is an independent risk factor for cardiovascular disease.

Dr. Mohanty: Thank you for having me, Dr. Bawa on this podcast. It's a pleasure to, talk to you and, come up current on the topics.

Dr. Bawa: Thank you so much for coming. Our listeners definitely need this discussion.

Dr. Mohanty: Yes, certainly it is a very hot topic and a lot of my patients, they do ask these questions. We get a lot of cardiac clearance for, patients for ED, and, other, medications.

02: 36 | How Common Is ED in Cardiac Patients?

Dr. Bawa: Great. Let's launch right in. Let's start with the topic at hand, the connection between ED and heart disease. According to research, well over half the men diagnosed with heart disease have. How often do you see it in your patient population?

Dr. Mohanty: We see a lot of patients with ED and actually ED has been, seen in even younger patients. So we have patients in the age group of, early thirties. they can go into their forties and definitely in the fifties, sixties and seventies.

Dr. Bawa: As you mentioned, ED seems to start surprisingly early in life. 30% of men in their thirties, 40% in their forties, and so on, about 10% for every decade of life. Now let's talk about age and the risk of heart disease.

Dr. Mohanty: After the age of 45, in men, they tend to have increased risk of, cardiovascular incident. Whether it is, high cholesterol, whether they have high blood pressure, whether they will have heart attack or a stroke. These continue to, increase with and other risk factors will, participate and will make it even, worse,

03: 46 | Smoking and Shared Cardiovascular Risk Factors

Dr. Bawa: I often tell my patients about the dangers of smoking when it comes to erectile function. Smoking also affects the risk of heart disease. Please tell our listeners about that.

Dr. Mohanty: Smoking is actually by far the most, aggressive and the most important of all the risk factors in which I have seen in my practice in my practice, followed closely by diabetes. Patients who are smokers tend to have everything from involvement of their entire vascular system, and they will have increased risk of heart attack, increased risk of stroke. They have peripheral arterial disease, they can have chronic limb ischemia, meaning lack of blood flow to the leg and have the highest risk of amputation. And if these patients also have diabetes or high blood pressure with it, they definitely will have a shorter lifespan compared to somebody who does not have these risk factors. So smoking, I would say probably stands on the highest of all the parameters in cardiovascular disease.

Dr. Bawa: See, this is what I always tell them. I stand validated based on what you're telling us. Now let's talk about other risk factors for heart disease.

Dr. Mohanty: The other risk factors for heart disease include, as I said, after smoking comes, diabetes and, high blood pressure, high cholesterol, age being a male, low testosterone is also part of this, syndrome and also family history. These will make generally the most common, risk factors for coronary artery disease or atherosclerosis in men or women, both.

05: 21 | Low Testosterone, ED and Heart Disease

Dr. Bawa: Testosterone seems to be quite the important player here. It's also low in men who suffer from ED quite often. And of course, low testosterone is also an independent risk factor for heart disease.

Dr. Mohanty: Absolutely. Very good point. So people think about as testosterone is a male, boosting hormone, but with that it comes with a lot of advantages, especially when young people tend to have a low testosterone. They are at increased risk of heart disease, ischemic stroke, development of diabetes, and high cholesterol. Testosterone really plays a very, very important role in maintaining, good homeostasis in the male. With low testosterone, you can develop something called metabolic syndrome, which can then lead to more obesity and development of diabetes. You can also get sleep apnea, high cholesterol, and an increased risk of stroke and heart disease. When it comes to testosterone, maintenance of the testosterone level is extremely, extremely important.

Dr. Bawa: Yes, and I find that low testosterone levels are often the cause for ED and some of the younger men.

Dr. Mohanty: That is correct. So the testosterone, when it comes to ED, you find younger patients starting at the age of 35 to 40 and then going further beyond correction, or bringing the testosterone level to normal, has been found more beneficial in younger patients compared to older patients. Studies done in Mayo Clinic and in Cleveland Clinic have shown. If testosterone therapy is given to older patients, they have very minimal cardiovascular benefits, but in younger patients, the benefit is immense, provided they are not using it for bodybuilding or as an anabolic steroid.

07: 06 | Testosterone Therapy in Younger Men

Dr. Bawa: So basically what you're telling us is that testosterone can actually be preventive if taken at a young age for the risk of heart disease.

Dr. Mohanty: Absolutely. Patients who will have low testosterone at the age of 30 or 35, 40, 45. They need therapy for normal body functioning, whether to keep muscle mass, manage cholesterol, or support function at a microvascular level. It works on endothelial function as well as nerve function. And that's what basically leads to erectile dysfunction. Erectile dysfunction is a combination of neurological as well as vascular complications. Low testosterone plays a major role in these patients because of endothelial dysfunction, which is the lining of the blood vessels and can lead to spasm and low blood flow, which then leads to erectile dysfunction. Low testosterone has also been found to be very important in the nerve conduction, and any kind of neuropathy, et cetera could lead to erectile dysfunction.

08: 06 | COVID, Endothelial Dysfunction and ED

Dr. Bawa: You know, it's interesting you brought up endothelial dysfunction because when COVID happened, I saw a spike in patients coming in for erectile dysfunction, and coincidentally, I noticed that their ages were getting lower and lower, and it was found to be a case of endothelial dysfunction. Again, that was being caused by COVID. And again, there was that testosterone link where men with lower testosterone were more likely to die of COVID. and also COVID was causing men who were coming in with normal testosterone to have levels that were plummeting. So that's another interesting point, isn't it, with COVID and testosterone and heart disease.

Dr. Mohanty: Yes. That is a very, good observation. I think you made and bringing that point up because a lot of my patients have lot of questions regarding this. So in my clinical practice, I have definitely found that after COVID, there was a large increase in heart attacks as well as blood clots in the lungs, blood clots in the legs, which is predominantly an endothelial dysfunction problem. Patients who tend to have low testosterone, they already have a problem with their endothelial dysfunction as well. They can have spasm and low blood flow, low nitric oxide. And that will then lead to increase in clotting as well as increased heart attacks, increased blood clots in the lungs, known as pulmonary embolism and erectile dysfunction. It is scientifically proven that this is the real reason why these patients are coming in with these problems.

09: 42 | What Dr. Bawa Saw After COVID

Dr. Bawa: Yes. And you know, initially when it started happening I asked myself, am I imagining this? And then I thought, no, I'm not imagining this. They are getting younger and more and more are complaining of it and it was worsening in the ones who already had it. So it was definitely cause and effect. There was no denying it. And when the studies came out, I said, “Hallelujah, there it is.” So at least then I had some numbers to tell my patients. Now certain blood pressure medications can also cause ED, and I see this most often with beta blockers, particularly Metoprolol. What are your thoughts about this?

10: 12 | Beta Blockers, Metoprolol and Erectile Function

Dr. Mohanty: Metoprolol has been a drug, of choice for high blood pressure, for heart failure, even tremors, et cetera, for quite some time, since the late 1960s. But being a beta blocker, it blocks adrenaline. That plays a major role in bringing down both the libido as well as performance. And, erectile dysfunction is very common in, patients with beta blockers, especially in younger patients. And if the younger patients tend to have a low testosterone, Starting them on a beta blocker could be devastating for their erectile dysfunction and can, lead to a lot more, depression as well as, other psychosomatic problems.

11: 04 | Why a Detailed Medical History Matters

Dr. Bawa: When I do my histories with my patients and I do a pretty thorough history, sometimes they get irritated. They say, why do I have to answer all these questions? And I say, because it matters. I really need to get to the basis, to the very reason why you have ED. And sometimes we can find simple fixes. Not always, but sometimes we get lucky. And when I mention Metoprolol, they say, okay, I'm stopping that today. And I say, no, no, no, you're going to talk to your cardiologist. And many times they say to me, well, I don't see a cardiologist. And when I asked them, have you ever seen one? They say, no.

Dr. Mohanty: I agree with that completely. Especially patients who have, low testosterone and patients who are on beta blockers. They may be taking the beta blocker for, heart arrhythmia. They may be taking for high blood pressure and maybe even after a heart attack, and abruptly stopping the beta blockers can definitely cause, some serious problem. It should be not be done by themselves, but with instructions from your primary care physician or taking advantage of a cardiology consultation. But again, the low testosterone plays a major role in these patients. And because their sex life and ED seem to be the priority, they tend to, forget about the medication. And they would rather not take that medication and take a chance, and to have a better, sex life as well as, better performance in the bedroom.

12: 56 | When Cardiac Screening Should Begin

Dr. Bawa: Words of wisdom right there. Now, before we get into Viagra and Cialis and that whole story, let's talk about the current recommendations for cardiac screening.

Dr. Mohanty: That is, again, a very good question, and, cardiac screening should begin at a very early age. Initially, when I was in my training, they used to do screening at the age of 50 or 55. That has now dropped. As per the American College of Cardiology guidelines, we do cardiac screening for patients at the age of 39 and above. These numbers will continue to come down as we are finding more and more patients. Especially post-COVID, a lot of things have changed. Patients are coming with low testosterone, they're coming with high cholesterol. They are coming with things like blood clots and strokes. So the screening age will certainly continue to go down, and I would start screening patients as early as 30 years of age for low testosterone, cholesterol, and coronary calcium scoring.

14: 16 | Calcium Scores, Stress Tests and Cardiac CT

Dr. Bawa: And what about stress tests in these patients?

Dr. Mohanty: So current guidelines say that if you are at the age of 39 or above, first thing they would screen is your cholesterol. And if your cholesterol, your LDL, which is the bad cholesterol is on the high side, means it is running more than 100 to 150. At that point, we recommend something called a coronary calcium score. A coronary calcium score is a non-invasive test, which is done with a CAT scan, and they actually take into account the amount of calcium built up in your coronary arteries or the arteries around the heart. The scores are graded from 0 to 100, 100 to 399, and 400 and above. In those patients, different guidelines are followed. If their calcium scores are very high, aggressive control of the cholesterol with statins is recommended.

16: 23 | Shockwave Therapy and Vascular Plaque

Dr. Bawa: Now in patients with cardiac disease and blockages, cardiac stenting and cardiac caths can be invasive, but sometimes necessary. However, with patients with ED, Sometimes we are so lucky to catch them on the earlier end of it, that with shockwave therapy, which is completely painless, despite that scary name, we can have such great results chipping away at those blockages and plaques that men can often restore excellent blood flow with.

Dr. Mohanty: That, that is correct. I think that is a very new, non-invasive way of treating ED in many patients where, especially atherosclerosis of the pudendal artery has been noted. In those patients, if they have calcification, they’re diabetic with low testosterone, and they have early ED, shockwave therapy is very good. Shockwave therapy. We also do it for coronary arteries. when the artery has got a lot of calcium and we are unable to deliver a stent, we use these, Shockwave balloons. We put inside the coronary artery, break up the calcium, and then we are able to successfully put in a balloon or a stent.

Dr. Bawa: Isn't that interesting? Except you do it a little differently than I do.

Dr. Mohanty: That is correct. Yeah. You do it a lot less invasively. We do it very invasively.

17: 43 | Viagra, Cialis and the Underlying Problem

Dr. Bawa: Yes. And it's such a great adjunct to what I do because I have so many men coming for erectile dysfunction from all over the world, and I think that this is such a great non-invasive way that helps function. It helps blood flow. It is just a really, really great tool that I have. And so many men around the world, millions are taking the little blue pill. Viagra and millions also take medications like Cialis. While these medications can help men, they don't actually solve the problem. But with shockwave therapy, we can often solve at least the structural problem with plaques. And given the fact that the number one cause of ED is blockages, these medications don't help with that at all.

Dr. Mohanty: Yes, absolutely. With these pills, as you said correctly, the basic problem with ED is an obstructive blockage in the pudendal artery, which then leads to the problem. By using these, medications, we are just temporarily increasing the flow, but the blockage where it is, the flow does not really improve. So you may see a very temporary release, and, of the spasm or increase in the blood. but it would not be a permanent solution for that. And number two, these patients can be on some other heart medications. And taking these drugs can cause an abrupt lowering of your blood pressure and there is a black box warning for patients who are on nitrates because, literally, it can kill them.

Dr. Bawa: You want to know something interesting? I have seen this during my ER career. Men would come in literally having had MIs during sex because they would be on these medications, Viagra, whichever one they were taking, and you know, if they wanna sue me, they can sue me. It'll just make me more famous. the reality is what it is.

Dr. Mohanty: That is a very good observation you made. And these drugs are very temporary solution, especially older patients, like to, take it because, but the older patients are also the patients who have coronary artery disease and they're on multiple medications. So interactions with these medications can sometimes cause very serious side effects and sometimes even fatal side effects. So cautious use of these medications in older patients. The same goes for younger patients. They need to get to the bottom of the problem, whether it is related to low testosterone or an actual blockage of the artery, which should be treated first rather than just trying these, medications.

20: 29 | Nitric Oxide, Testosterone and Erectile Function

Dr. Bawa: Yes. And in fact I have a nitric oxide booster as part of the Dr. Sex Fairy line of supplements. I also have a testosterone booster because I feel that these are so important to good erectile function. You have to have good blood flow with the nitric oxide and you have to have good testosterone levels. And we do regular hormone therapy with creams and shots and everything, but some men don't want to be on that. They want to improve their levels naturally. So at least now we also have that option available for them.

Dr. Mohanty: Yes. For a good performance of an engine, just like you need good oil and a good filter. In case of a good performance for men in the bedroom, you need all these, including a a good testosterone level, clean pipes, and no blockages.

21: 22 | The Debate Around Testosterone

Dr. Bawa: Absolutely. So Dr. Mohanty coming back to testosterone, it's really getting a bad reputation nowadays. The anti hormone lobby saying, oh, this is terrible. This is actually not good. It's not natural. It's got so many side effects. What do you have to say to that?

Dr. Mohanty: That is one of the most interesting questions in through this meeting. There is bad propaganda on testosterone, but if testosterone were a bad hormone, we would not have had it in our body. We need testosterone for normal functioning, especially for young men. It is very, very important not only for sex, but also for muscle building, clear thinking, focusing a good night's sleep. Lack of these hormones would lead them to something called andropause, very similar to menopause in females. Hence, the role of testosterone remains very controversial. Patients who tend to have normal testosterone and they are using it to bump up their testosterone so that they can do more muscle building.

So the bottom line is: use testosterone therapy and boosters for patients who are young and they have low T levels and they want to get into a normal homeostasis for their body. Avoid using testosterone in older patients and in patients who have normal testosterone for bodybuilding, anabolic steroid purposes, or to enhance their sex drive, I do not recommend in those patients. Those are the ones who will have the side effects and then will ultimately bring in bad propaganda.

23: 38 | The Risks of Poorly Supervised Testosterone Therapy

Dr. Bawa: I am using testosterone in a lot of men and I am using it in some older men, but of course I am monitoring their levels very closely and I am not overmedicating them. A big problem I’m noticing is that all these websites have come up where they don’t even know who they’re talking to, and they have no real doctor associated with the website. It's just a corporation, and I think a lot of damage is being done by these websites because they're not really monitoring these patients like they should. A little bit of testosterone can go a long.

Dr. Mohanty: Absolutely. I agree 100%. There are many of these companies that have started testosterone therapy because they see it is a big market. So they are using testosterone therapy for any kind of patient who walks in and they say their testosterone is low or they feel low normal, they feel low, energy. And without a real supervision of a physician. It is being administered by many, allied healthcare, professionals and sometimes they don’t even follow the levels. Very interestingly, since you brought that up, I actually have a few patients who have gone to these, clinics, and I'm not going to name. They actually had frank heart attacks and cardiac arrest. We had to revive them, clean the clot out of their, blood vessels. And some of them even needed stents, et cetera. But they made it.

25: 33 | Finding Dr. Mohanty and Final Advice

Dr. Bawa: It's really sad because testosterone is not the enemy; I think substandard medical care is., I think testosterone, absolutely. You know, testosterone is a good thing. That's why, like you said, we have it, but thank you so much for this discussion and for taking time out of your busy day. You are in your office right now and I'm at mine, so thank you for doing this for us and our listeners. And how can people find you for cardiac consultations?

Dr. Mohanty: People can definitely find us, through our website. It's Advanced Cardiovascular Consultants and we have three offices in. County of, Palm Beach and West Palm Beach, Palm Beach Gardens, and Jupiter. We have a very nice website. They can go there. We have a patient portal also where they can sign up and can get appointments.

Dr. Bawa: Thank you so much once again for coming. This has been such a great conversation.

Dr. Mohanty: Thank you for having me on the podcast

26: 34 | Closing: Think About Your Heart

Dr. Bawa: And to my listeners, I am sure you learned so much from Dr. Mohanty today. I am definitely going to invite him back on the podcast. So make sure you submit your questions to me. You can always email them to askme@drsexfairy.com. So let's just end with this idea. If your penis isn't working very well, think about your heart first. Until next time.